Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

VA Technical Reference Model v 25.1

NCPDP Real-Time Prescription Benefit (RTPB) Standard
NCPDP Real-Time Prescription Benefit (RTPB) Standard Standard or Specification

General Information

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

Website: Go to site
Description: The NCPDP RTPB standard enables the real-time exchange of patient-specific eligibility, product coverage (including any restrictions and alternatives), and estimated cost sharing so prescribers have access to this information through a RTBT application at the point-of-prescribing. This proposed rule, as currently codified at § 423.160(b)(7), CMS requires that Part D sponsors implement one or more electronic RTBTs that are capable of integrating with at least one prescriber`s electronic prescribing system or electronic health record, as of January 1, 2021; however, at the time CMS established this requirement, no single industry RTPB standard was available. NCPDP has since developed an RTPB standard. We propose to require the most current version, NCPDP RTPB standard version 13, as the standard for prescriber RTBTs at § 423.160(b)(5) starting January 1, 2027. June 17, 2024, CMS published the Part D AND Office of the National Coordinator for Health IT (ONC) final rule: Finalize change to Part D requirements for electronic prescribing standards. Revises current regulatory text to cross-reference the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations for requirements related to standards for eligibility transactions. Part D sponsors are required to implement one or more electronic real-time benefit tools (RTBTs) capable of integrating with at least one prescriber`s electronic prescribing system or electronic health record. CMS does not currently require compliance with a standard for RTBTs. This updated rule introduces the requirement standard Real-Time Prescription Benefit (45 CFR 170.205(c)). Effective date for adoption of Real-Time Prescription Benefit (RTPB) is 1/1/2027. Membership required to access standard. Please contact the VHA Office of Standards & Interoperability (Mailgroup: vhas&iresponseteam@va.gov) prior to implementation to obtain guidance and the VHA-endorsed version of this standard.
Technology/Standard Usage Requirements: Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information:
Decision: View Decisions
Decision Source: TRM Mgmt Group
Decision Process: One-VA TRM v24.12
Decision Date: 12/16/2024 at 20:45:49 UTC
Introduced By: TRM Request
Standards Body: NCPDP
- The information contained on this page is accurate as of the Decision Date (12/16/2024 at 20:45:49 UTC).